Residents of rural Appalachian Kentucky suffer rates of type II diabetes mellitus (DM) that are among the highest and most rapidly increasing in the country. Members of grandparent headed households (GHH), one of the fastest growing family constellations in rural Appalachian Kentucky and the US, may be particularly vulnerable to health threats elevating their risk for DM. While the literature provides a starting point for the examination of this health disparity, little is known about the socioecological factors that influence the risk for DM among GHH. Given the increasing prevalence of GHH, their vulnerability to health threats, and the current lack of information about their DM risk factors, w propose to holistically examine the socio-ecological context of the health of GHH in rural Appalachian Kentucky in order to implement a culturally and contextually appropriate family intervention to reduce diabetes risk. We will conduct a two phase mixed methods study that culminates in a feasibility trial of such an intervention in rural Appalachian Kentucky. Phase I of the proposed study will utilize a simultaneous mixed methods design to assess socioecologic and biological risk of diabetes for GHH family members via surveys, biological measures, in-depth interviews with family members, key informants interviews, and a community assessment. Seventy families that are headed by a grandparent, have one or more family members at risk for diabetes, and include at least one grandchild ages 10 to 14 will be included in this phase of the study, with 20 of those families participating in the in-depth qualitative interviews. Phase II of he study will include selection and refinement of an appropriate intervention to reduce diabetes risk for the families. Based on phase I findings and existing literature we will select an evidence based intervention and refine it to be culturally and contextually appropriate for the rural Appalachian families that are the focus of this project, in collaboration with our strong network o community partners. Finally, we will test he feasibility and acceptability of the refined intervention with 10 GHH. The proposed study will serve as the foundation for interventions for families in other rural areas with notable diabetes disparities.